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July 7, 2008

Dwindling Community InvolvementA Sign of Professional Failure to Thrive?

Arch Pediatr Adolesc Med. 2008;162(7):695. doi:10.1001/archpedi.162.7.695

In this issue, Minkovitz et al1 document pediatricians' decreased community involvement. I recommend this article as a must read, not so much for its methodology and statistics but as a stimulus to reflection by both individual pediatricians and our profession on the questions “Why?” and “So what?”

Lying open on my desk is the AMA Code of Medical Ethics. I have read and reread principle VII: “A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.”2 The greatest privilege of my professional life was spending 20 years delivering pediatric care in the Harriet Lane Clinic of Johns Hopkins Hospital in Baltimore. For me, that experience is a vivid reminder of the responsibility of which principle VII speaks. In the after-clinic hours of particularly discouraging days, I remember thinking often that our devoted health care team could do little in the end to improve the health—in the most meaningful sense of that word—of the children of East Baltimore if we confined our activities within the walls of the health care site. Indeed, I sometimes pondered whether what we were doing could best be described as trivial and distracting compared with the needs of the children and families in their communities and as neglectful of the real leverage points for change.

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